Acute Hospital, Community, and Indirect Costs of Stroke Associated With Atrial Fibrillation

Abstract

A trial fibrillation (AF) increases the risk of stroke, disability, dementia, and death, with a characteristic profile of more severe, disabling, and recurrent stroke compared with stroke without AF. [1][2][3][4] With aging populations, the prevalence of AF is projected to increase ≥2-fold by 2050, accompanied by an increase in the frequency of AF-associated stroke. 5 Accurate health economic data are important to inform health policy decisions to respond to this societal increase in AF prevalence, such as population screening programs. Reliable data on the cost of stroke associated with AF (AF-stroke) are also essential for rigorous cost-effectiveness studies of new oral anticoagulant agents, which guide reimbursement decisions for healthcare providers internationally. [6][7][8][9] Existing hospital-based studies have described high costs of stroke associated with AF. [10][11][12][13][14][15] However, existing studies have been limited by the reporting of acute hospital costs only, or by the inclusion of selected AF-stroke subgroups, such as hospitalized patients, nonaphasic patients, those with first-ever stroke only, or 1-year survivors. No cost studies of AF-stroke have been performed in unselected patients, including costs of community healthcare and indirect costs associated with lost productivity, leading to substantial underestimation of the Background and Purpose-No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents. Methods-In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices). Results-In 568 patients ascertained in 1 year (2006), the total estimated 2-year cost was $33.84 million. In the overall sample, AF-stroke accounted for 31% (177) of patients, but a higher proportion of costs (40.5% of total and 45% of nursing home costs). On a per-patient basis compared with non-AF-stroke, AF-stroke was associated with higher total (P<0.001) and acute hospital costs (P<0.001), and greater nursing home (P=0.001) and general practitioner (P<0.001) costs among 90-day survivors. After stratification by stroke severity in survivors, AF was associated with 2-fold increase in costs in patients with mild-moderate (National Institutes of Health Stroke Scale, 0-15) stroke (P<0.001) but not in severe stroke (National Institutes of Health Stroke Scale ≥16; P=0.7). Conclusions-In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner cos...

Societal Costs of First-Incident Ischemic Stroke in Patients with Atrial Fibrillation—A Danish Nationwide Registry Study

“…The hospital and residential care costs amounted to US $20,037 and US $16,148, respectively. Moreover, our cost estimates are significantly lower than the estimates made by Hannon et al [11], who investigated the costs of stroke associated with AF among 177 patients in Ireland. They estimated the average 2-year costs associated with AF-strokes to be US $76,602 in 2007 prices, including acute hospital, nursing home, community health care, and indirect costs.…”

“…We found only two large studies on the costs of stroke in patients with AF, and these studies included only hospital costs [8,9]. Previous studies have shown that the costs of stroke are higher in patients with AF than in patients without AF [8][9][10][11]. Additional studies are needed to ensure that valid cost estimates can be used to strengthen the foundation for evidence-based decision making regarding the treatment of AF and prevention of future strokes.…”

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

“…6,7,[19][20][21] We acknowledge that our methodology for calculating the cost might be inaccurate, but the value is close to that reported in recent literature. 22 A list of all parameters and their values is presented on the On-line Table. There are several assumptions made in this model:…”

The Impact of Ischemic Stroke on Atrial Fibrillation-Related Healthcare Cost: A Systematic Review

“…Only two of the 15 studies discounted the cost at certain rates, therefore the reported cost may not be an accurate reflection of actual cost. Indirect costs were only reported in a small proportion of studies 24,44,45 , which would hinder the overall cost estimation required for an assessment from the societal perspective. For labor market outcomes, the lack of research on the relevant costs of productivity loss 44,45 is also apparent.…”

“…The median LOS estimate reported from these studies was 15.5 days per episode. The longest median LOS of 21 days (IQR: 60 days) was in Ireland 24 , while an average LOS of 5.2 days for non-repeated stroke admissions and 6.8 days for repeated stroke admission in the USA were reported as the shortest 25 among the included studies.…”